정상 한국인에서 연령증가에 따른 혈장 Dehydroepiandrosteronesulfate ( DHEA-S ) 농도 및 DHEA - S / cortisol 비의 변화

박성우,유형준,임성희,최문기,유재명,박민숙,이권엽,박철수,김철홍,김현규,김두만,박규용 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.2

Backgroud: DHEA-S is the most abundant steroid hormone in circulation, and primarily secreted from the adrenal cortex, but its physiological role is little known. One of the characteristic features of DHEA-S is progressive decrement of plasma DHEA-S level with advancing age, in contrast, plasma levels of other adrenal hormones are not chaging or littie decreasing. To grasp the trends of plasma DHEA-S level and DHEA-S/cortisol ratio by age in healthy Korean, we measured the plasma DHEA-S levels and DHEA-S/cortisol ratios in healthy Korean. Methods: Healthy Korean(men: 99, women: 102, age range: 15-97 year old)were studied. Subjects were not taking drugs(such as glucocorticoid or androgenic medication) or cigarettes known to modify the plasma level of DHEA-S and cortisol, and had no evidence of hepatic, renal disease or hyperlipidemia as determined by serum lipid, bilirubin, SGOT, SGPT, BUN, creatinine. Data were analyzed by 10-year age group for men and women: i.e, 10-19, 20-29, 30-39, 40- 49, 50-59, 60-69, 70-79, 80-89 and 90 year or more. Plasma DHEA-S levels were measured by using a commercially available RIA kit with 125I labeled-DHEA-SO4(Coat-A Count DHEA-SO4), and for the measurement of plasma cortisol levels, commercial Gamma Coat TM[125I] Cortisol Radioimmunassay Kit was used. Results:. 1) In both men and women, plasma DHEA-S level showed high interindividual variation within the same age group. 2) There were individual sex differences in plasma levels of DHEA-S, in all age groups, plasma DHEA-S levels were significantly higher values for men than for women. 3) Maximum plasma DHEA-S levels(men; 237+-3.35 ug/dL, women; 108+-17.5 ug/dL) were at third decade in both men and women. 4) Both men and women showed the continuous decline in plasma DHEA-S level with age. These age-related decline was more prominent in men than in women(men; y= -3.152 * +292.6, r2= 0.8459, P$lt;0.05, women; y= -1.417 * +143.3, r2 = 0.7278, P$lt; 0.05). 5) As an index of aging, there was no stastical difference between DHEA-S and DHEA- S/cortisol ratio. Conclusion: In healthy Korean, there were high interindividual variation of plasrna DHEA-S levels. In both men and women plasma DHEA-S level was peak at third decade, and from when it declined progressively with age. These results suggest that although the reliability of single plasma DHEA-S measurement are limited, the decline of DHEA-S with advancing age might be a specific marker of endocrinologic hormonal milieu(aging index). Also, concerning to individual adrenal secreting capacity, we measured DHEA-S/cortisol ratio. But we did not found that plasma DHEA-S/cortisol ratio is superior to the plasma DHEA-S level as an aging index. (J Kor Soc Endocrinol 12:245-254, 1997)

한국인 폐확산능 정상예측식의 임상적 유용성과 정확성

나승원 ( Seung Won Ra ),박태선 ( Tai Sun Park ),홍윤기 ( Yoon Ki Hong ),홍상범 ( Sang Bum Hong ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2

연구배경: 폐확산능을 해석하는 데 필요한 정상예측식으로는 한국인을 대상으로 하여 박 등이 개발한 식(박 식)이 있으나 아직 외국 정상예측식을 많이 사용하고 있다. 이에 국내에서 많이 사용하는 외국 정상예측식인 Burrows 식과 박 식의 임상적 유용성과 정확성을 비교하고자 하였다. 방법: 1. 임상적 유용성 연구; 2006년 7월부터 12월까지 6개월간 폐확산능검사를 시행한 환자 중 두 식을 각각 정상예측식으로 적용하였을 때 폐확산능 해석이 다른 276명(대상군 A)을 대상으로 하였다. 대상군 A에게 두 식을 각각 적용하였을 때 폐확산능 해석과 임상적 판단과의 일치도를 비교하여 임상적 유용성을 평가하였다. 2. 간질성폐질환 진단의 정확성 비교; 2001년부터 2006년까지 폐조직검사를 시행하여 확진된 간질성폐질환군과 서울아산병원에서 모집한 정상군을 대상으로 하여 정상예측식으로 두 식을 각각 적용하였을 때 폐확산능 해석의 정확도를 비교하였고, 두 식이 차이가 나는지 맥니머의 카이스퀘어 검정을 하였다. 결과: 1. 임상적 판단과의 일치도 비교; 276명을 임상정보를 토대로 폐확산능을 예측하여 분류한 결과 정상 54명, 감소 220명, 불분명이 2명이었다. 예측식으로 박 식과 Burrows 식을 적용하였을 때 임상적 판단과 일치하는 환자는 각각 78%와 22%이었다(p<0.001). 2. 간질성폐질환 진단의 정확성 비교; 박 식은 민감도 90.1%, 특이도 100%이었고 Burrows 식은 민감도 64.2%, 특이도 100%로 민감도가 통계학적으로 유의하게 박 식이 높았다(p<0.001). 결론: 우리나라 정상예측식인 박 식이 외국 정상예측식인 Burrows 식을 정상예측식으로 적용하는 것보다 임상적 유용성이나 간질성폐질환 진단의 민감도에서 더 우월하였다. 향후 폐확산능검사의 정상예측식으로 박 식을 사용해야 할 것으로 사료된다. Background: Park et al. developed the Korean reference equation for the measurement of diffusing capacity in 1985. However, the equation has not been widely used in Korea and foreign reference equations have been popularly used. We intended to compare the clinical usefulness and the accuracy of the the Korean reference equation (Park`s equation) with that of the foreign equation (Burrows` equation) that is commonly used in Korea. Methods: 1. Evaluation of clinical usefulness; Among 1,584 patients who underwent diffusing capacity (DLCO) at the Asan Medical Center from July to December 2006, group A subjects included 276 patients who had different interpretations of DLCO in trials employing Burrows` equation and Park`s equation. Clinical assessment was decided by consensus of two respiratory physicians. In order to evaluate the clinical usefulness of Burrows` equation and Park`s equation, agreement of clinical assessment and DLCO interpretation were measured. 2. Evaluation of accuracy; Group B subjects were 81 patients with interstitial lung disease (ILD) and 39 normal subjects. The 81 ILD patients were diagnosed following a surgical lung biopsy. The accuracy of diagnosing ILD as well as sensitivity and specificity were evaluated according to the use of the reference equations (Burrows` equation and Park`s equation) for DLCO. Results: Agreement between clinical assessment and interpretation of DLCO was 22% for the use of Burrows` equation and 78% for the use of Park`s equation. The sensitivity and specificity of the Burrows` equation for diagnosing ILD were 64.2% and 100%. The sensitivity and specificity of the Park`s equation for diagnosing ILD were 90.1% and 100%. The sensitivity of the Park`s equation for diagnosing ILD was significantly higher than that of Burrows` equation (p<0.001). Conclusion: The Korean reference equation (Park`s equation) was more clinically useful and had higher sensitivity for diagnosing ILD than the foreign reference equation (Burrows` equation). (Tuberc Respir Dis 2008;64:80-86)

Wuthering Heights 硏究 : 사랑과 복수를 中心으로

朴相滿 건국대학교 1986 論文集 Vol.23 No.1

This thesis is a study of Emily Bronte‥'s only novel, Wuthering Heiths Chiefly the fatalistic love of Heathcliff and Catherine And Heathcliff's Vengenance upon those around him, Hindley: Edgar Linton, Hareton, Isabella, and the love of Hareton and cathy, are also studied.Emily Bronte‥ who lived all her life located in Haworth, moorland of Yorkshire, left dozens of poems and only anti novel, Wuthering Heights and ended life at the age of thirty in 1848. Emily Bronte‥ si passionate as well as gloomy, and lacks stability, being abundant in wit along with eloquence, On the other hand, She is energetic, practical, stubborn as well as prosaic, and she has a silent temper of Yorkshire The Striking Constrast between heredity from parents and circumstances, plays as important role in forming the essence of her writings. Her life in her own closed world and her violent feelings thus repressed are considered to have produced such a romantic love-story as Wuthering Heights. Wuthering Heights is characterized by mighty and unrestricted passions, and a moderated softness, namely the two contradictory characters, passion and Sweetness. The story which Emily Bronte‥'s Novel, Wuthering Heights develops is a drama of love and hatred. The history of the two families, the Earnshaws and the Lintons of Yorkshire is one of love entangled in vehement passion and revenge over a periods of three generations. Heathcliff's love is never one to be allowed by the standard of social reasons because he devoted his life to the love of Catherine, and he deprived persons who interfered with his love of all their property. Catherine's love is not righteous, either, by the judgement of morral Conscience. while she loved Heathcliff, she was married to Edgar Linton and besides she loved heathcliff as Edgar's wife. Heathcliff's cruel vengeance disregared social morality and manners, and he was out of the range of the Consciousness of virtue and vice as well as beyond the limit of life and death. He was devoted only to Indulgence in primitive passion. Heathcliff was curt, blunt and the owner of a violent personality. He developed an inexhaustible passion for Catherine and pursed a course of cruel revenge against the Earnshaws and the Lintons. Heathcliff was transformed into a man of rough, persistent and rustic character, gradually receiving severe maltreatment from Hindley. In the world of Wuthering Heigths, hatred flaming with limitless revenge and inhumane cruelty flourishes in a context of endless love. The love of Hareton and Cathy in the end of the novel gives light on the sombre and gloomy situations, keeping the balance of the novel. Their love starts as the love between Heathcliff and Catherine did, but is Certainly expected to be normal and peaceful in the future. In Wuthering Heights, Emily Bronte‥ let us the instruction that make us realize the truth that a man who can boundlessly hate someone is a man able to love somebody endlessly.

체지방 측정기(Futrex-1000 body fat tester)로 측정한 소아의 체지방율에 관한 연구 : 학동기와 청소년기 아동을 대상으로

박상철,이동환,신상만,이상주,박준수,최석민,안재억 순천향대학교 1992 논문집 Vol.15 No.2

Using the infrared interactance(NIR method), the percentage body fat in 1,401 Korean children, aged 6-18years, was evaluated for normal and standard values. Correlation of percentage of body fat with age, weight, height, overweight(%), Kaup index and Rohrer index was also analyzed. The following results were obtained ; 1) In all the subject, weight and height showed standard growth(50-90 percentile) compared to growth data of korean children. 2) The percentage of body fat was decreased with increasing age and was measured higher in female than male. 3) The percentage of body fat was decreased with increasing height in both sex. 4) The percentage of body fat correlated negatively with age, heght, weight in both sex. In boys, the Rohrer index appeared to have a significant positive correlation with the percentage of body fat. (r=0.52454) In girls, the overweight(%) appeared to have a significant positive correlation with percentage of body fat. (r=0.56994) The Kaup index had no correlation with the percentage of body fat. This NIR method is safe, non-invasive, rapid, easy to use, and may be useful predict percentage of body fat, especially in the mass screening.

도시근린공원의 편익비용분석 : 청주시를 대상으로 A Case of Chongju

권상준,명현,박구원,이만희 청주대학교 산업과학연구소 1993 産業科學硏究 Vol.11 No.-

As a consequence of this study, the analyses of urban community parks in Chongju are as follows; 1. The total benefit of three scenarios can be calculated at 200,031, 255,197, 368,411 million Won, respetively depending on the scenario, which of the percentage of indirect benefit is 57.7%, 49.3%, 53.3% respetively in the order of the scenario . 2. The total cost can be calculated at 231,840 million Won. 3. The ratio of Benefit and Cost comes out in the order of the scenario 3, 2, 1, depending on the relative importance factors according to the benefit. 4. The priority of developing community parks depends on the hiearchical order factors: location, developed area, scale of parks.

증산의 풍수관(風水觀) 고찰 - 『전경(典經)』을 중심으로 -

박상만,Park, Sang-man 대진대학교 대순사상학술원 2015 대순사상논총 Vol.25 No.2

Master Jeungsan understood a general view of Pungsu but actually he used the theory of Pungsu in his own religious perspective, transcending it. The theory of Pungsu is different. But the fact that it is premised on the principle of 'in and yang', the five-element principle, the Book of Changes, energy thought, and To chugi piyung, etc. is generally recognized. The three important elements of Pungsu are mountain, water, and direction or man. Pungsu has formal principles such as Gallyongbeop, Jangpungbeop, Deuksubeop, Jeonghyeolbeop, Jwahyangbeop, and Hyeongukron. etc. In the late of Joseon, Jeungsan established a new traditional thought, understanding Bibopungsu, Gukdopungsu, Minganpungsu, etc. However, he reinterpreted them to be suitable to his religious ideal and let his followers understand them as well. In particular, Jeungsan overcame the previous view on earth and expressed a new perspective to enhance earth up to the level of heaven. In the perspective of the traditional world, earth is lower than heaven, but Jeungsan made it a status equal to heaven. He mentioned that in the past, the culture and history of man was influenced by earth's energy but today, at the age of man respect, he put passive man influenced by earth-condition on the more subjective and active status. Even though he mentioned different Pungsu, Hyeongguk, and Hyeolmyeong, he expressed the shape of Pungsu within the construction of three worlds, the one of heaven and earth transcending good or ill luck or a favorable change in fortune. He practised the expedient of Pungsu from the stand of the construction of heaven and earth instead of the usage of Bibopungsu, Gukdopungsu, and Minganpungsu. He diagnosed that the division of the world is caused by the one of earth and tried to solve it. Moreover, he said that Myeongdang(a propitious site) must be the man-orientation rather than the earth-orientation. It means that Pungsu, stressing the energy of earth and turning one's luck, is changing into the world of man-orientation. In other words, Jeungsan diagnosed the world of Pungsu but he ultimately used Pungsu theory in building up his own view of religious world transcending such a theory.

토마스 하디의 『비운의 주드』에 나타난 사회부적응 문제 고찰

박상만 ( Park Sang-man ) 대한영어영문학회 2008 영어영문학연구 Vol.34 No.2

This thesis aims to investigate the aspects of social inadaptability in Jude the Obscure. This work really develops into a battle between reality and ideal. The hero Jude is confronted with ruin by the struggle between Arabella for physical sexuality and Sue for spiritual one. Jude the Obscure, one of the best works in the Victorian Age, shows the aspects of his gloomy and deterministic viewpoint. In this work, The hero Jude seeking for social success arrives at the downfall in the end due to his burning desires that he tries to get over social problems. However, Jude’s characteristic weakness, strong sexual impetus, and habitual drinking cause the hero to destroy his life. In this work, Hardy indicates the structural contradiction regarding education, marriage, and religion problems in the Victorian age. Hardy deals with inner problems of human beings oppressed by the convention of the time. Jude attempts to live his life according to his own nature, rejecting social convention. In the work, Jude continues to struggle against his life to the end, and finally the hero Jude is destroyed by the social inadaptability. We can feel venerable as we see Jude fight against Fate to the end in spite of his character defects. Therefore, we can reach the conclusion that Hardy’s literature creates the lofty beauty of men’s spirit. (Wonkwang University)

在美 韓國 老人의 健康 및 生活 實態에 關한 硏究

金應翊,朴祥華,韓允愚,徐敬萬 대한보건협회 1992 대한보건연구 Vol.18 No.1

This study was perfomed to figure out the health status and life style of aged population in Korean-Americans living in Los Angeles in the United States. The number of subjects in this study were 283 persons aged 65 and over (male 141. female 142) drawn from Los Angeles Country in U.S.A. The data were collected by trained interviewers from July to August. 1991. The questionaire consisted of 1) general characteristics, 2) health status and medical health services, 3) 24 questions of CMI, and 4) the level of adaptations and difficulties to immigrant society. The results of this study are as followings: 1. In age distribution, 33.2 percent of total subjects was 65-69 age group, and 33.1 percent was 70-75 age group. The average duration of immigration were 7.89 years in male and 10.18 years in female, and percent distribution by duration of migration were 33.3 percent in 1-4 years, 30.5 percent in 5-9 years, 23.7 percent in 10-14 years, and 13.5 percent in 15 years and over. Of total subjects. 84.7 percent had permanent residence and only 13.8 percent had citizenship. In the reason of immigration of the elderly, 76.4 percent of them responded as reason for helping and joining to family, and only 8.5 percent of subjects were economic reason. The educational level of the subjects were generally high. Only 9.0 percent of the subjects recevied no or little education in the modern day education system. Primary graduates were 35.7 percent, middle and high school graduates were 37.8 percent and university(college) and over graduates constituted 16.6 percent. The educational level of the male were generally higher than that of female. A large proportion of the subjects(94.3 percent) responded as having religion, and 67.8 percent were protestant, 16.7 percent were catholic and 7.4 percent were buddhist. In the family structure. 75.6 percent of the elderly lived alone and with their spouses and 22.1 percent live in a family with 2 generation living together. The marital status of male showed that 80.7 percent of them lived with their spouses, 14.3 percent of men were widowed, and only 26.3 percent of female lived with their spouses and 71.5 percent of female were widowed. 2. One out ten of the elderly was presently smoking. Of the smokers, there were 4 times as many male smokers as female smokers. In response to a question about their drinking habits, 82.0 percent of the aged replied that they did not consume alcohol. Those who consumed alcohol 'daily' constituted 3.6 percent, 'frequently' were 4.3 percent 'sometimes' were 7.9 percent and 'scarcely' constituted 2.2 percent. Among the exercises and sports which the elderly were doing for the fitness and preservation of health. A walking was the most popular at 32.1 percent of the population. More rigorous sports such as hiking, jogging, physical cardiovascular exercises and ball games were being enjoyed by only a very few. 37.2 percent of the elderly replied that they did not exercise regularly. In the major pastime of daily life activities. 40.9 percent of the subjects responded 'none', 14.7 percent of them were domestic duty for family, about 10 percent of them were hobby, religion activities, social work and participating in social education program respectively. In the problems and difficulties of immigration, 78.1 percent of them responded 'yes' in the early times of immigration and 30.4 percent in the present time of immigration. Six major problems were identified by respondent. They were, in the rank order of their language; homesickness: transportation; income and economic and custom. 3. Most of the respondents considered themselves healthy. The proportion of the question to their health at the time of study, 36.2 percent in male and 23.2 percent in female replied that they seemed to be 'excellent healthy', 34.7 percent in male and 32.4 percent in female be 'good', and 4.3 percent in male and 2.1 percent in female be 'Very poor'. In considering specific parts of their body as having problems, many of the ederly pointed out the disease of circulatory system(17.7 percent in male and 23.2 percent in female). Comparatively few of the elderly thought that they had something wrong with their musculoskeletal system(5.7 percent in male and 16.1 percent in female), digestive system(9.2 percent in male and 5.6 percent in female) and endocrine and metabolic disease(6.4 percent in made and 9.9 percent in female). Of those elderly who perceived of some problems with their circulatory and musculoskeletal systems, there were more elderly women compared to elderly men. The largest percentage of the elderly(20.7 percent in male and 26.5 percent in female) indicated palsy as the disease they fear most. Thereafter, the order of diseases feared by the elderly was diabets. hypertension, neuralgia, cancer, and dotage. A majority of the elderly, 54.6 percent of men and 44.4 percent of women, replied that they did not visit a medical institution or a pharmacy to treat their diseases during the one month prior to the survey. Of the total survey subjects who did visit a medical facilities, those complaining of circulatory system disease constituted 13.5 percent in male and 14.8 percent in female, and digestive system diseases were 7.8 percent in male and 8.5 percent in female. For the endocrine and metablic disease, disease of nervous and sens organs and musculoskeletal system were all each less than 7 percent of all the study subjects. Of the total elderly, 49.0 percent utilized medical facilities such as hospitals, herbal clincics, pharmacies and others to treat illness within one month prior to the time of survey; the utilization of clinicl and hospital were 86.0 percent, herb clinic were 8.4 percent and pharmacy were 4.2 percent. 34.8 percent of men and 11.3 percent of female did not take a medicine for treatment and promoting nutrition at the time of the survey. 55.4 percent of total elderly used the drug for treatment of diseases, and 16.6 percent for promoting nutrition. 4. Except for group of questions concerning urinary system more women than men generally complained of problems and discomforts in each groups. More elderly suffered from problems associated with musculoskeletal system than any others, and the decreasing order of the groups of problems with which most complaints were indicated are the problems associated with mental condition, urinary system, circulatory system, nervous system, visual and auditory organs, respiratory system and digestive system.

개에서 이중 결찰법을 통한 동맥관 개존증의 완치 예

윤헌영,정순욱,박희명,박철,정만복,김준영,한현정,황민,노병국,박상혁,장하영,박정윤 한국임상수의학회 2004 한국임상수의학회지 Vol.21 No.1

A ten months old, female Yorkshire terrier weighing 2.88 kg referred to veterinary teaching hospital of college of veterinary medicine, Konkuk University because of syncope, cough and dyspnea. First hematological and serum chemical test revealed thrombocytopenia, mild anemia, and increase of concentration of ALP (195 U/L). On 57 days later, second hematological and serum chemical test revealed polycythemia, increase of concentration of ALP (211 U/L), and Tchol (387 mg/dl). Right atrium enlargement, main pulmonary artery bulge and cardiomegaly (VHS = 11.5) were observed in radiographic findings. Ultrasonographic images showed both right and left ventricular dilation and turbulent flow between the descending aorta and the main pulmonary artery in color Doppler imaging. ECG showed left ventricular enlargement, SA block, and electrical alternant. Thoracotomy was performed through left fourth intercostal incision under isoflurane anesthesia. Patent ductus arteriosus was double ligated with 1-0 silk. Cough and dyspnea disappeared on 5 days after operation. Turbulent flow was not found in color doppler imaging of ultrasonography on 10 days after operation. Ten months later after the operation, syncope could not exist any more.

사지의 주요 동맥손상의 처치: 23증례에 대한 분석

원형섭,김상은,배성만,박철완,이 근,조상훈,김상일,우병완 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Extremity vascular trauma is common in most emergency centers, and controversy remains about the optimal management of arterial injuries. Retrospectively we reviewed the records of 23 patients who had upper or lower extremity arterial trauma from July 1994 to December 1995. The purpose of this study was to evaluate our department`s management policy to major arterial injuries. The leading cause of major arterial injuries was penetrating trauma. We found that there were clinical findings such as absence of or decreased strength of pulsation(82.6%), cool ischemic extremity(69.6%), large expanding hematoma(43.5%), major bleeding(17.4%) and bruit or thill(8.7%). We gave the priority to management of life-threatening injuries and applied the pressure dressing to wounds as early as possible. There were 18 men(78.3%) and 5 women(21.7%); the mean age was 35(range 20-56 years old) years. There were 12 arterial injuries(52.2%) in the upper extremity and 11 arterial injuries(47.8%) in the lower exteremity. The most commonly injured artery was the brachial artery in the upper(34.8%) and the femoral artery in the lower(30.4%) extremity. The etiology included knife stabbing in 10 patients(43.5%), motor vehicle accidents in 6(26.1%), industrial accidents in 4(17.4%), falls in 2(8.7%) and a farm equipment accident in 1 patient(4.3%). The associated injuries were muscle injuries(78.3%), fracture(56.5%), nerve injuries(52.2%), vein injuries(43.5%), shock(17.4%) and dislocation(13.0%). All patients with arterial injuries were given a preoperative prophylactic antibiotic and TIG(tetanus immunoglobulin). We used Doppler technique as a means of detecting the blood flow. Fourteen patients(60.9%) underwent preoperative arteriography in the radiology department. We performed surgical exploration as soon as major arterial injuries were suspected. The most common methods of treating major arterial injuries were interposition vein graft(69.6%) and end to end anastomosis(21.7%). Systemic or locally infused heparin was used for all vascular repairs. In many of our patients(56.5%), fasciotomy was performed before the vascular repair, as a part of the exploration of the distal arteries. There were 2 amputations(8.7%) but no death. The reason for secondary amputation were wound infection in one and failure to achieve sufficient arterial flow to the involved extremity with resulting gangrene in the other. As the time factor is vitally important in the management of arterial injuries, we advocate prompt and early surgical treatment within 6 hours of the trauma. In conclusion, we believe that the crucial factorsin successful management of major arterial injuries of the extremities are early diagnosis, prompt treatment, complete debridement, fasciotomy when indicated, and simultaneous treatment of concomitant injuries.